Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: A comparative risk assessment

Background: High blood pressure, blood glucose, serum cholesterol, and BMI are risk factors for cardiovascular diseases and some of these factors also increase the risk of chronic kidney disease and diabetes. We estimated mortality from cardiovascular diseases, chronic kidney disease, and diabetes that was attributable to these four cardiometabolic risk factors for all countries and regions from 1980 to 2010. Methods: We used data for exposure to risk factors by country, age group, and sex from pooled analyses of population-based health surveys. We obtained relative risks for the effects of risk factors on cause-specific mortality from meta-analyses of large prospective studies. We calculated the population attributable fractions for each risk factor alone, and for the combination of all risk factors, accounting for multicausality and for mediation of the effects of BMI by the other three risks. We calculated attributable deaths by multiplying the cause-specific population attributable fractions by the number of disease-specific deaths. We obtained cause-specific mortality from the Global Burden of Diseases, Injuries, and Risk Factors 2010 Study. We propagated the uncertainties of all the inputs to the final estimates. Findings: In 2010, high blood pressure was the leading risk factor for deaths due to cardiovascular diseases, chronic kidney disease, and diabetes in every region, causing more than 40% of worldwide deaths from these diseases; high BMI and glucose were each responsible for about 15% of deaths, and high cholesterol for more than 10%. After accounting for multicausality, 63% (10·8 million deaths, 95% CI 10·1-11·5) of deaths from these diseases in 2010 were attributable to the combined effect of these four metabolic risk factors, compared with 67% (7·1 million deaths, 6·6-7·6) in 1980. The mortality burden of high BMI and glucose nearly doubled from 1980 to 2010. At the country level, age-standardised death rates from these diseases attributable to the combined effects of these four risk factors surpassed 925 deaths per 100 000 for men in Belarus, Kazakhstan, and Mongolia, but were less than 130 deaths per 100 000 for women and less than 200 for men in some high-income countries including Australia, Canada, France, Japan, the Netherlands, Singapore, South Korea, and Spain. Interpretation: The salient features of the cardiometabolic disease and risk factor epidemic at the beginning of the 21st century are high blood pressure and an increasing effect of obesity and diabetes. The mortality burden of cardiometabolic risk factors has shifted from high-income to low-income and middle-income countries. Lowering cardiometabolic risks through dietary, behavioural, and pharmacological interventions should be a part of the global response to non-communicable diseases. Funding: UK Medical Research Council, US National Institutes of Health. © 2014 Elsevier Ltd

頸動脈硬化病変と生活習慣との関連性について : 過疎化、高齢化率の進んだ一地域、新見市千屋地区住民を対象として

健康長寿、QOLの向上は私たち誰もが持つ願望であり、健康日本21で示すように生活習慣病対策は個々人にとって重要な課題である。岡山県の山間、過疎地域の50歳から70歳の住民80名の希望対象者に頸動脈エコー検査を実施し、同時にライフスタイルチェックを行った。受検者76名(男性22名、女性54名)の平均年齢は男性63.1歳、女性62.2歳であった。男女別のライフスタイルチェックでは、日常生活活動、食生活習慣、休養習慣ともに女性の得点取得率が高く、運動習慣の男女平均取得率は7.5%と最も低かった(有意差なし)。頸動脈エコー検査結果は正常範囲群28名、軽度所見あり群41名、中等度以上の所見あり群7名(うち高血圧治療中3名)であった。頸動脈エコー検査結果からライフスタイルチェックをみると、正常範囲群と比較し中等度以上の所見あり群の平均得点取得率が高かった項目は、日常生活活動、食生活習慣、ライフスタイルチェックの合計点であり、中等度以上の所見あり群の方が生活習慣に関しては普段から十分注意していることが示唆された。Healthy long life and improvement of QOL are everybody\u27s desire. According to Project Healthy Japan 21, precautions against lifestyle-related diseases are important issues for individuals. We carried out carotid artery echo examinations and life style questionnaire to residents, from 50 years to 70 years of age, in a depopulated mountainous area of Okayama Prefecture. The average ages of the 76 examinees (22 males and 54 females) are 63.1 years of age for male and 62.2 for female. In the life style questionnaire to both genders, female examinees scored higher in sections such as daily life activities, dietary habits, and relaxation habits. The average percentage of who has regular exercise is 7.5% in both genders combined (no significant difference between the genders). Regarding the results of carotid artery echo examinations, 28 examinees were in the group of normal range, 41 in the group of minor findings, and 7 in the group of more than medium findings (including 3 persons under hypertension treatment. When we relate the results of carotid artery echo examinations to life style questionnaire, people in the group of more than medium findings score higher in categories of daily life activities, dietary habits and total scores of life style questionnaire. It can be noted that people who are in the group of more than medium findings are careful enough in their daily lives

短大教職員及び市役所事務系職員の仕事のストレス

職場におけるメンタルヘルス対策は重要な課題である。職業性ストレス簡易調査票を用いて短大教職員と事務系職員の職業性ストレスを比較した。対象者は旧A市役所職員300名(男性225名、女性75名)、短大教職員55名(男性21名、女性34名)。平均回収率54.9%。平均年齢は41.8歳(標準偏差±11.5歳)であった。短大教職員は事務系職員と比較し仕事の要求度(仕事の量、スピード、複雑さ)、仕事のコントロール(仕事の裁量権や自由度等)が有意に高かったが、同僚の支援は有意に低かった。上司の支援に有意の差はなかった。また、ストレスの量-コントロール判定図および職場の支援判定図からみた仕事のストレス判定図の結果、事務系職員の総合健康リスクは92.0、短大教職員は87.0であり、全国平均の総合健康リスク100と比較し事務系職員は8.0%、短大教職員は13.0%健康リスクが低くなっていた。Mental health at work has been an important subject. We have examined job stress among junior college staff in comparison with civil servants. Participants: 300 (225 males and 75 females) civil servants in a city government and 55 (21 males and 34 females) junior college staff. The average collection rate is 54.9%. The mean age was 41.84±11.5 years old. The present sample of junior college staff shows meaningfully higher job demands (amount of task, speed and complexity) and task control (discretion and flexibility of task performing) than civil servants. Junior college staff shows significantly lower support rate from their colleagues than civil servants. There is no significant difference on support rate from their bosses. In terms of stress levels which are shown in diagrams of stress measurement combined with diagrams of stress control and support, general health risk level of civil servants is 92.0, while that of junior college staff is 87.0. Compared with national average of general health risk level 100, the level of civil servants is 8.0% lower and that of college staff is 13.0% lower